Serum Uric Acid as Biomarker for Diagnosis of Metabolic Dysfunction Associated Steatotic Liver Disease

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most recent designation for steatotic liver disease linked to metabolic syndrome. It is a widespread condition that currently affects an estimated one third of adults worldwide. This study evaluated serum uric acid levels and their diagnostic significance for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) among 162 males and 182 females. Mean uric acid levels were significantly higher in males (8.05 mg/dL) compared to females (7.85 mg/dL) (P = 0.012). Male values demonstrated slight right skewness, whereas females showed greater variability and heterogeneity. Receiver Operating Characteristic (ROC) analysis revealed excellent diagnostic performance of uric acid for MASLD, with Area Under the Curve (AUC) values of 0.9924 in males and 0.9301 in females, indicating very high predictive accuracy. Cost-threshold and rotated ROC analyses identified gender-specific optimal cutoff values. The most effective diagnostic thresholds were approximately 7.19 mg/dL for males and 6.12 mg/dL for females, highlighting important biological differences in uric acid metabolism between genders. In males, a cutoff around 7.0–7.5 mg/dL achieved high sensitivity with minimal false-positive rates. Elevated uric acid was strongly associated with metabolic dysfunction, insulin resistance, and oxidative stress, supporting its role as a low-cost and reliable biomarker for early MASLD screening. These findings suggest that gender-specific serum uric acid thresholds may improve the diagnostic accuracy and clinical assessment of MASLD.